Two years after a damning report into the care provided to children with disabilities are who living in foster care, the Ombudsman's for Children's office (OCO) has again expressed concern about a lack of progress in this area.

The OCO has published a new report, Molly Two Years On, which acknowledges that major progress has been made to improve the supports and services available to children with moderate to profound disabilities who are in the care of the State.

However, the report also identifies significant areas of concern, particularly when it comes to the HSE, which two years later, has still not identified hundreds of children with disabilities in foster care, and so cannot adequately plan for their care.

The OCO originally published Molly's Case in 2018. Molly was born with Down syndrome and has severe autism. She had been abandoned by her biological parents at birth. Now aged 16, she has grown up with the same foster family she was placed with soon after birth.

Molly is dependent on her foster carers for feeding, toileting, bathing, and dressing.

"When Molly's foster carer came to us, we found that neither the HSE nor Tusla saw Molly as a child in care and also a child with a disability. There was a lack of coordination which meant that services and supports provided by both organisations were insufficient.

"We also found that according to Tusla, there were 471 other children like Molly, yet neither Tusla nor the HSE had a good enough system in place to ensure adequate supports were being provided," explained the Ombudsman for Children, Dr Niall Muldoon.

He pointed out that when Molly's Case was published in 2018, both the HSE and Tusla made a number of "significant and ambitious commitments".

The OCO revisited the case in 2019, but was not satisfied with the progress made, so it decided to give the HSE and Tusla another 12-months to fulfil their commitments.

"It is now 2020 and two years after Molly's Case was first published, we are pleased to see that Tusla in particular has been extremely proactive in addressing the issues raised by Molly's foster carers, and identifying other children who are in a similar position.

"Molly, who at one time was in danger of being transferred to institutional care, is still at home in a loving family environment, resulting in a saving of at least €90,000 per year for the Exchequer. Both Tusla and Molly's carers must be commended for this," Dr Muldoon said.

He noted that the HSE and Tusla are now working more closely together for children like Molly and her family. However, he described it as "incomprehensible" that two years on, "the HSE has still not managed to come to an agreement with Tusla to identify the children in State care nationally with moderate to profound disabilities".

"The HSE and Tusla have worked together to identify the children in this cohort who will turn 18 in 2019/2020, but cannot do the same for younger children. This suggests a focus on the financial implications to their budget, rather than a drive to plan for and provide the best care," he insisted.

Dr Muldoon said that it is "imperative that every effort is made to support all the exceptionally committed foster carers that are looking after children with moderate to severe disabilities".

"Without their loving care and commitment, these children would be facing a life in residential care. However, in order to provide the appropriate support, there must be consensus among those involved as to who these children are.

"Molly's case has been extremely important in shining a light on a small and extremely vulnerable cohort of children who were unrecognised within the system. These children are no longer invisible," he pointed out.

He added that as the Ombudsman for Children, he cannot close this case as he is not satisfied that the situation has improved enough for children with disabilities in the care of the State.

"It is my intention to submit a copy of this report to both the Oireachtas Joint Committee on Health and the Oireachtas Joint Committee on Children and Youth Affairs. In an effort to mirror the level of cooperation required for this case I will be urging the two committees to come together and review the report jointly so as to address the issues arising," Dr Muldoon added.

The report, Molly Two Years On, can be viewed here.